management of pelvic injuries - cpb-eu-w2.wpmucdn.com

Christine Gaarder, PhD,

Departement of Traumatology

Oslo University Hospital Ullevål

Management of pelvic injuries

Treat physiology

Pelvic bleeding sources

Veins, arteries, bones

Associated injuries 90%

Extrapelvic bleeding 50%

Abdominal bleeding 30% Biffl WL et al. Ann Surg 2001

You don’t know what’s bleeding

…address all sources

A B C D E

Primary Survey

Secondary Survey

Treat physiology

Assume coagulopathy

Coagulopathy

Hypothermia Acidosis

Loss The treatment of bleeding

is to stop the bleeding!

MTP

C Lee and K Porter, Emerg Med J, 2007

Bottlang M et al. J Trauma 2002

Angio or Theatre ?

Angiographic

embolization works !

Total pelvic# <10%

HD unstable 50-80%

45 vs 130 mins

Osborn PM, et al. Injury 2008

45 vs 130 mins

J Trauma 2014

Why pelvic packing?

Why extraperitoneal…?

Intraperitoneal

doesn’t work!

..”always” preceded by

laparotomy..

..”and followed by AE”

Effect on arterial

bleeding ?

Ertel W et al. J Orthop Trauma 2001

Delayed flow in the internal iliac artery

Reduced

Pelvic Packing

Pelvic Packing –Do we need it?

Exsanguinating patient (before angio)

Before transfer if angio not available

Satsingsområde ?

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